Tag: pubmed

Lasers Med Sci. 2025 Jun 20;40(1):291. doi: 10.1007/s10103-025-04540-6.

ABSTRACT

Perioral aging manifests as fine lines, wrinkles, and structural changes, often requiring specialized treatment. Although laser systems are widely used in facial rejuvenation, few studies directly compare their efficacy in perioral rejuvenation. This study evaluates and compares the efficacy and safety of two laser systems-Erbium: glass laser and Nd: YAG combined with Er: YAG laser-for perioral rejuvenation. A prospective, comparative clinical trial was conducted with 36 female patients who sought perioral rejuvenation at a tertiary dermatology hospital. Participants were randomly assigned to either the erbium: glass group or the Nd: YAG combined with Er: YAG group, each receiving three treatment sessions at 4-week intervals. Efficacy was assessed through clinical wrinkle severity ratings, VisioFace^® imaging, and patient satisfaction scores. Safety was evaluated by monitoring adverse events. The mean ages in the erbium: glass and Nd: YAG combined with Er: YAG laser groups were 49.78 ± 6.59 and 46.72 ± 6.36 years, respectively, without significant difference (p > 0.05). All participants had Fitzpatrick skin types III- IV. Both treatment groups demonstrated significant improvements in supralabial lines and skin hyperpigmentation (p < 0.05). While erbium: glass was more effective in reducing supralabial lines, the difference between the two laser systems was not statistically significant. Conversely, improvement in corner lip wrinkles was statistically significant only in the Nd: YAG combined with Er: YAG laser group (p < 0.05). Erbium: glass showed significantly superior results in reducing pore count (p < 0.05). No significant difference was observed between the groups in terms of skin hyperpigmentation improvement. Both erbium: glass and Nd: YAG combined with Er: YAG laser are effective and safe options for perioral rejuvenation. Erbium: glass may be particularly suited for targeting superficial lines and pores, while Nd: YAG combined with Er: YAG laser appears more effective for treating deeper wrinkles. These findings support an individualized laser treatment selection approach based on specific skin concerns. Further studies with larger sample sizes and extended follow-up periods are recommended to confirm and expand on these results.

PMID:40537663 | DOI:10.1007/s10103-025-04540-6

JMIR Res Protoc. 2025 Jun 19;14:e66722. doi: 10.2196/66722.

ABSTRACT

BACKGROUND: Hypothermia in young infants presenting to the emergency department (ED) may indicate a serious bacterial infection (SBI) such as a urinary tract infection, bacteremia, or bacterial meningitis. Improved understanding of the epidemiology of SBI in infants with hypothermia and the development of prediction models can help avoid unnecessary invasive procedures and antimicrobial exposure.

OBJECTIVE: The aim of the study is to (1) describe the epidemiology of SBI and herpes simplex virus (HSV) among infants with hypothermia, (2) assess the role of biomarkers in predicting SBI, and (3) derive and internally validate a multivariable predictive model for SBI among infants with hypothermia.

METHODS: The study is being conducted through the Pediatric Emergency Medicine Collaborative Research Committee as a retrospective nested case-control study. We will include infants with hypothermia (rectal temperature<36.5 °C) presenting to 1 of 28 pediatric EDs in the United States between January 1, 2013, and December 31, 2022. Exclusion criteria will include (1) fever in the ED or prior to ED arrival, (2) transfer from another health care facility, (3) technology dependence, (4) trauma, (5) skin and soft tissue infections, and (6) presentation in cardiac arrest. The primary outcomes will be culture-confirmed SBI (objectives 1-3) and HSV-positivity (objective 1). The analytic approach for each objective will be (1) to use descriptive statistics to summarize the epidemiology of SBI and HSV and clinical outcomes, (2) to compare biomarker parameters of infants with and without SBI and determine optimal cutoff values using a receiver operator characteristic curve, and (3) to develop a multivariable predictive model using penalized mixed effects logistic regression within a 1:3 case-control sample among infants in the cohort who had a blood culture obtained.

RESULTS: Data collection for this study is ongoing, with a collection of data from 21 hospitals at the time of protocol submission. Of 16 sites evaluated in preliminary analysis (n=45,673), the median age is 25 (IQR 6-52) days, and 24,182 (52.9%) are male. In total, 340 (0.7%) infants have an SBI, of whom 103 had bacteremia or meningitis. Mortality occurred in 7 (2.1%; 95% CI 0.9%-4.3%).

CONCLUSIONS: We will use a consensus-based outcome measure for SBI with an established data acquisition pathway. We will use a multicenter sample from US children’s hospitals, using a consensus-based outcome measure for SBI and a case-control approach to evaluate outcomes to improve the management of young infants with hypothermia in the ED.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/66722.

PMID:40536806 | DOI:10.2196/66722

Omega (Westport). 2025 Jun 19:302228251353548. doi: 10.1177/00302228251353548. Online ahead of print.

ABSTRACT

Most patients dying in hospitals die outside of specialist palliative care, making healthcare professionals of all disciplines responsible for the care of the dying. This cross-sectional study assessed how burdened healthcare professionals on non-palliative care hospital wards are when caring for dying patients. Descriptive and inferential statistics (chi² and t tests) were used to analyze the data. N = 201 healthcare professionals on ten non-palliative care hospital wards participated in the survey (four general wards, six intensive care units). Intensive care unit staff reported a higher total burden related to care in the dying phase than general ward staff (d = 0.41; p = .005). “High demands of caring for dying patients”, “unexpected death”, and “special relationship with informal caregivers” were the most severe and prevalent burden factors in healthcare professionals. Results show specific burden factors that should be prioritized when implementing interventions to reduce burden in healthcare professionals.

PMID:40536794 | DOI:10.1177/00302228251353548

J Craniofac Surg. 2025 Jun 19. doi: 10.1097/SCS.0000000000011565. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to analyze the changes in trabecular bone architecture in the condylar neck and angulus regions of the mandible in patients who were treated with surgically assisted maxillary extension (SARME) using fractal analysis (FA) techniques.

METHODS: The study included 37 patients who underwent SARME operation for maxillary transversal deficiency in the Department of Oral, Maxillofacial and Maxillofacial Surgery. Fractal values (FV) were measured from the right and left condyle neck and angulus on panoramic radiographs before and 6 months after the operation.

RESULTS: As a result of the analysis, statistically significant changes were found in the bilateral condyle neck in pre and postoperative FV scores (P<0.05), whereas the changes in the angulus region were not statistically significant (P>0.05).

CONCLUSIONS: This study concludes that changing occlusion and masticatory forces after SARME surgery change the bone structure in the condyle region of the mandible, increase trabeculation and therefore FV.

PMID:40536787 | DOI:10.1097/SCS.0000000000011565

NEJM Evid. 2025 Jun 19:EVIDoa2500115. doi: 10.1056/EVIDoa2500115. Online ahead of print.

ABSTRACT

BACKGROUND: A predictive model for early-stage classic Hodgkin’s lymphoma (cHL) does not exist. Leveraging patient-level data from large clinical trials and registries, we developed and validated a model that we term the Early-Stage cHL International Prognostication Index (E-HIPI) to predict 2-year progression-free survival (PFS).

METHODS: We developed the model using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) guidelines in 3000 adults with newly diagnosed early-stage cHL from four international phase III clinical trials conducted from 1994 to 2011. External validation was performed in two cohorts, totaling 2360 treated patients from five international cHL registries (1996 to 2019). Two-year PFS was estimated using a Cox model with pretreatment variables selected using backward elimination. Internal validation corrected for overfitting. External validation assessed discrimination and calibration. The final model was also compared against European Organisation for Research and Treatment of Cancer (EORTC) favorable or unfavorable status.

RESULTS: The median age in the development cohort was 31.2 years; 77.4% had stage II disease. The estimated 2-year PFS was 93.7%. Final variables retained in the model were sex and continuous values of maximum tumor diameter (MTD), and levels of hemoglobin and albumin. The optimism-corrected C statistic in the development cohort was 0.63 (95% confidence interval, 0.60 to 0.69). Two-year PFS was lower in the validation cohorts 1 (90.3%) and 2 (91.6%). In validation cohort 1, the C statistic was 0.63 and the calibration slope was near 1, but overall calibration indicated underprediction, which improved on updating the intercept. The performance was similar in validation cohort 2. In addition, higher-risk E-HIPI scores were associated with worse outcomes in both the EORTC unfavorable and favorable subgroups. When included altogether in one Cox model, the E-HIPI was associated with PFS, whereas EORTC favorable or unfavorable status was not. Online risk calculators were developed (https://rtools.mayo.edu/holistic_ehipi/).

CONCLUSIONS: Utilizing objective, continuous, and readily available variables, we developed and validated a new prediction model for early-stage cHL. Male sex, lower hemoglobin or albumin levels, and higher MTDs were associated with worse PFS. (Funded by the National Cancer Institute; grant number, NCI R01 CA 262265-04.).

PMID:40536772 | DOI:10.1056/EVIDoa2500115

Ir J Med Sci. 2025 Jun 19. doi: 10.1007/s11845-025-03991-8. Online ahead of print.

ABSTRACT

BACKGROUND: Average screen time has increased drastically after the COVID-19 pandemic. It has raised concerns about the adverse effects, including the effect on BMI.

AIM: The present study is conducted to study the relationship between screen time and BMI among medical students at a medical institute in Lahore, Pakistan.

METHODS: For this cross-sectional study, a sample of 370 medical students and residents was obtained from a medical institute in Pakistan. An online survey to gather data about screen time activities, device usage, and BMI. Screen time was categorized into low (1-2 h/day), moderate (3-4 h/day), and high (5-6 h/day), while BMI score was calculated and categorized into under-weight, normal, overweight, and obese groups. Descriptive and inferential statistics including Spearman correlation analysis were applied using IBM SPSS 25.0.

RESULTS: Most participants fell into the normal BMI category (79%), with a smaller proportion classified as overweight (16%) or obese (5%). Most participants preferred using smartphones (92.1%). About 41% of participants had high screen time. There was a strong positive correlation between low screen time and normal BMI (r = 0.999). However, only 2.9% of the participants had low screen time. The link between higher screen time and obesity is observed especially in males, while females maintain a more stable normal weight, suggesting gender-based lifestyle or metabolic differences.

CONCLUSION: Screen time is significantly associated with BMI with a strong positive correlation as well. There is need to design educational programs to raise awareness about the safe use of devices and the amount of screen time.

PMID:40536737 | DOI:10.1007/s11845-025-03991-8

Ir J Med Sci. 2025 Jun 19. doi: 10.1007/s11845-025-03980-x. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by focal demyelinating lesions, axonal dysfunction/degeneration, and gliosis, which can lead to various clinical disabilities. Visual evoked potentials (VEP) is sensitive and repeatable techniques capable of monitoring significant short-term changes in neuroaxonal integrity and alterations in nerve conduction triggered by acute optic neuritis.

AIM: This study aims to evaluate whether VEP latency and amplitude could serve as subclinical predictors of clinical outcomes in MS patients over short-term follow-ups.

METHODS: This study was planned to include MS patients diagnosed according to the McDonald Criteria 18 who did not have any psychiatric, neurological, or ocular disorders that could interfere with the main purpose. The VEP test was performed for routine evaluation of demyelination or axonal damage.

RESULTS: A total of 83 patients were included in the study, with a mean age of 33.6 ± 9.3 years. Of all the patients, 54 were female (65.1%) and 29 were male (34.9%). Right pattern reversal visual evoked potential (PVEP) P100 (OR for PVEP1: 0.802, p = 0.001; OR for PVEP2: 0.879, p = 0.002) was statistically significant in showing right VEP abnormality at both baseline and at 6 months. Left VEP abnormalities were associated with left PVEP P100 at PVEP1 (OR: 0.852, p = 0.003) and left PVEP N75 at PVEP2 (OR: 0.935, p = 0.029).

CONCLUSION: VEPs have the potential to predict short-term subclinical stability or progression, making them valuable candidates for early treatment adjustments and evaluating future pharmacotherapy-supported remyelination.

PMID:40536736 | DOI:10.1007/s11845-025-03980-x

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11752-5. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to show that spectral computed tomography (CT) can identify different patterns of airway wall thickening and contrast enhancement in lung-healthy controls, coronavirus disease 2019 (COVID-19), and non-COVID-19 pneumonia patients, reflecting airway inflammation in both pneumonia subtypes and airway neovascularization in COVID-19.

MATERIALS AND METHODS: 331 subjects (age 58.9 ± 17.2 years) with 218 arterial and 113 venous phase spectral CT acquisitions were retrospectively recruited: 119 lung-healthy controls, 45 with COVID-19 and 167 with non-COVID-19 pneumonia. Scientific software was used for segmenting the airway tree. Wall thickness (WT_5-10) and the difference in median maximum airway wall attenuation (slope of the spectral attenuation curve) between 40 keV and 100 keV display energy were calculated and aggregated for subsegmental airway generations 5-10 (λHU_5-10). Descriptive statistics, correlations, t-tests, and ANOVA analyses were performed.

RESULTS: Arterial phase WT_5-10 was similarly increased in COVID-19 (1.70 ± 0.44 mm) and non-COVID-19 (1.64 ± 0.53 mm) pneumonia compared to controls (1.18 ± 0.34 mm, p < 0.001). Arterial phase λHU_5-10 was significantly higher in patients with COVID-19 pneumonia (3.09 ± 2.27 HU/keV) than in non-COVID-19 pneumonia (2.18 ± 1.54 HU/keV, p < 0.01) and lung-healthy controls (2.06 ± 1.11 HU/keV, p < 0.01).

CONCLUSION: Spectral CT shows significant differences in segmental wall thickness and airway contrast enhancement between COVID-19 and non-COVID-19 pneumonia and lung-healthy controls. Airway contrast enhancement may be a feasible measure to detect airway inflammation in pneumonia and neovascularization in COVID-19 pneumonia.

KEY POINTS: Question Is spectral CT airway contrast enhancement a feasible quantitative method to detect airway inflammation or neovascularisation? Findings Spectral CT shows significant differences in segmental wall thickness and airway contrast enhancement between COVID-19 and non-COVID-19 pneumonia, and lung-healthy controls. Clinical relevance Spectral CT can be used to assess inflammatory airway diseases such as cystic fibrosis, COPD, asthma and bronchiectasis.

PMID:40536704 | DOI:10.1007/s00330-025-11752-5

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11776-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate the chronic pancreatitis CT severity model (CATS), an artificial intelligence (AI)-based tool leveraging automated 3D segmentation and radiomics analysis of non-enhanced CT scans for objective severity stratification in chronic pancreatitis (CP).

MATERIALS AND METHODS: This retrospective study encompassed patients with recurrent acute pancreatitis (RAP) and CP from June 2016 to May 2020. A 3D convolutional neural network segmented non-enhanced CT scans, extracting 1843 radiomic features to calculate the radiomics score (Rad-score). The CATS was formulated using multivariable logistic regression and validated in a subsequent cohort from June 2020 to April 2023.

RESULTS: Overall, 2054 patients with RAP and CP were included in the training (n = 927), validation set (n = 616), and external test (n = 511) sets. CP grade I and II patients accounted for 300 (14.61%) and 1754 (85.39%), respectively. The Rad-score significantly correlated with the acinus-to-stroma ratio (p = 0.023; OR, -2.44). The CATS model demonstrated high discriminatory performance in differentiating CP severity grades, achieving an area under the curve (AUC) of 0.96 (95% CI: 0.94-0.98) and 0.88 (95% CI: 0.81-0.90) in the validation and test cohorts. CATS-predicted grades correlated with exocrine insufficiency (all p < 0.05) and showed significant prognostic differences (all p < 0.05). CATS outperformed radiologists in detecting calcifications, identifying all minute calcifications missed by radiologists.

CONCLUSION: The CATS, developed using non-enhanced CT and AI, accurately predicts CP severity, reflects disease morphology, and forecasts short- to medium-term prognosis, offering a significant advancement in CP management.

KEY POINTS: Question Existing CP severity assessments rely on semi-quantitative CT evaluations and multi-modality imaging, leading to inconsistency and inaccuracy in early diagnosis and prognosis prediction. Findings The AI-driven CATS model, using non-enhanced CT, achieved high accuracy in grading CP severity, and correlated with histopathological fibrosis markers. Clinical relevance CATS provides a cost-effective, widely accessible tool for precise CP severity stratification, enabling early intervention, personalized management, and improved outcomes without contrast agents or invasive biopsies.

PMID:40536703 | DOI:10.1007/s00330-025-11776-x

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11746-3. Online ahead of print.

ABSTRACT

OBJECTIVES: Body composition analysis (BCA) is a recognized indicator of patient frailty. Apart from the established bioelectrical impedance analysis (BIA), computed tomography (CT)-derived BCA is being increasingly explored. The aim of this prospective study was to directly compare BCA obtained from BIA and CT.

MATERIALS AND METHODS: A total of 210 consecutive patients scheduled for CT, including a high proportion of cancer patients, were prospectively enrolled. Immediately prior to the CT scan, all patients underwent BIA. CT-based BCA was performed using a single-slice AI tool for automated detection and segmentation at the level of the third lumbar vertebra (L3). BIA-based parameters, body fat mass (BFM_BIA) and skeletal muscle mass (SMM_BIA), CT-based parameters, subcutaneous and visceral adipose tissue area (SATA_CT and VATA_CT) and total abdominal muscle area (TAMA_CT) were determined. Indices were calculated by normalizing the BIA and CT parameters to patient’s weight (body fat percentage (BFP_BIA) and body fat index (BFI_CT)) or height (skeletal muscle index (SMI_BIA) and lumbar skeletal muscle index (LSMI_CT)).

RESULTS: Parameters representing fat, BFM_BIA and SATA_CT + VATA_CT, and parameters representing muscle tissue, SMM_BIA and TAMA_CT, showed strong correlations in female (fat: r = 0.95; muscle: r = 0.72; p < 0.001) and male (fat: r = 0.91; muscle: r = 0.71; p < 0.001) patients. Linear regression analysis was statistically significant (fat: R² = 0.73 (female) and 0.74 (male); muscle: R² = 0.56 (female) and 0.56 (male); p < 0.001), showing that BFI_CT and LSMI_CT allowed prediction of BFP_BIA and SMI_BIA for both sexes.

CONCLUSION: CT-based BCA strongly correlates with BIA results and yields quantitative results for BFP and SMI comparable to the existing gold standard.

KEY POINTS: Question CT-based body composition analysis (BCA) is moving more and more into clinical focus, but validation against established methods is lacking. Findings Fully automated CT-based BCA correlates very strongly with guideline-accepted bioelectrical impedance analysis (BIA). Clinical relevance BCA is currently moving further into clinical focus to improve assessment of patient frailty and individualize therapies accordingly. Comparability with established BIA strengthens the value of CT-based BCA and supports its translation into clinical routine.

PMID:40536702 | DOI:10.1007/s00330-025-11746-3